Over the past several years, we’ve heard moreand moreaboutxylitol as a means of preventing cavities. Does it work? As our regular readers know, the evidence has seemed mixed at best.

A new Cochrane review of the research confirms that suspicion. So far, there doesn’t seem to be enough good quality evidence to say much at all about xylitol’s ability to counter decay. Of the 10 studies the authors included, 7 were found to be “at high risk of bias.” Only one was considered at low risk.

Bias wasn’t the only problem, however. According to a press release on the findings,

In most cases, the studies used such different methods that the researchers could not combine the results to create a summary effect estimate. Based on information from 4,216 school children who took part in two Costa Rican studies, they found low quality evidence that levels of tooth decay were 13% lower in those who used a fluoride toothpaste containing xylitol for three years, compared to those who used a fluoride-only toothpaste. For other xylitol-containing products, such as xylitol syrup, lozenges and tablets, there was little or no evidence of any benefit.

So does this mean ditch the xylitol? Not necessarily. It does mean it’s something you probably don’t want to rely on to keep you caries-free.

Even researchers who found positive results have noted that xylitol “is not the silver bullet.”

Exercise is one of those things we all know we should do to stay healthy. Still, most of us fail to do enough of it. In fact, only about 20% of adults meet the standard guidelines for physical activity.

There are plenty of reasons why it can be so hard for so many of us to get up and moving more: time, money, stress, little perceived immediate payoff – you name it. And since we don’t really notice or feel the ill effects right away, it’s easy to forget this is a problem – until enough time has passed for those effects to pile up and drag us down.

One new paper powerfully shows not only how much of a difference exercise can make but how relatively quickly those changes become evident.

The study focused on identical twins whose exercise habits had significantly diverged in early adulthood. Before then, everything was generally the same: environment, diet, and, of course, genetics. With most of the subjects, the differences had arisen only within the last handful of years. The results, as reported by the NY Times, were profound.

The sedentary twins had lower endurance capacities, higher body fat percentages, and signs of insulin resistance, signaling the onset of metabolic problems. (Interestingly, the twins tended to have very similar diets, whatever their workout routines, so food choices were unlikely to have contributed to health differences.)

The twins’ brains also were unalike. The active twins had significantly more grey matter than the sedentary twins, especially in areas of the brain involved in motor control and coordination.

Presumably, all of these differences in the young men’s bodies and brains had developed during their few, brief years of divergent workouts, underscoring how rapidly and robustly exercising — or not — can affect health, said Dr. Urho Kujala, a professor of sports and exercise medicine at the University of Jyvaskyla who oversaw the study.

Granted, this study was small and hardly definitive. Yet it reinforces the point that we all “know” yet don’t always act on: Exercise matters. A lot.

One thing you might not be aware of is that there are oral health benefits to exercise, as well. Through recent years, research has shown that those who regularly exercise have a much lower risk of gum disease (which itself is linked to a wide variety of systemic inflammatory conditions, including heart disease, diabetes, stroke, kidney disease, Alzheimer’s and rheumatoid arthritis). Fitness and perio health very much seem to go together. A study published earlier this year in the Journal of Periodontology showed that gum disease may be a risk indicator for poor physical fitness, at least in males.

The crux of the matter: Our bodies were built to move. Just as a car left undriven for long periods of time runs less and less well when it is used – if it runs at all – so, too, our bodies.

When it comes to preventing tooth decay, conventional dentistry typically offers just a couple “solutions” beyond standard oral hygiene: sealants and fluoride. Of course, neither of these addresses the major cause of caries (cavities). As the editor of the British Dental Journalwrote there last summer,

It is…intriguing how when one asks a patient what causes tooth decay they answer “sugar” but when asked how to prevent it they respond “by brushing your teeth.” Confusingly there is merit in this…but the more logical answer would be to reduce or eliminate sugar.

But as a new study in PLOS Medicine shows, there’s a good reason why the most logical answer didn’t get emphasized.

A review of internal industry documents shows that the sugar biz didn’t like that tactic.

The sugar industry could not deny the role of sucrose in dental caries given the scientific evidence. They therefore adopted a strategy to deflect attention to public health interventions that would reduce the harms of sugar consumption rather than restricting intake. Industry tactics included the following: funding research in collaboration with allied food industries on enzymes to break up dental plaque and a vaccine against tooth decay with questionable potential for widespread application, cultivation of relationships with the [National Institute of Dental Research (NIDR)] leadership, consulting of members on an NIDR expert panel, and submission of a report to the NIDR that became the foundation of the first request for proposals issued for the [National Caries Program (NCP)]. Seventy-eight percent of the sugar industry submission was incorporated into the NIDR’s call for research applications. Research that could have been harmful to sugar industry interests was omitted from priorities identified at the launch of the NCP.

The authors draw an explicit parallel between these tactics and those of the tobacco industry. One of those authors, in fact, is the researcher known as the “Ralph Nader of the anti-tobacco movement,” Dr. Stanton Glantz. According to a report in Dr. Bicuspid,

“These tactics are strikingly similar to what we saw in the tobacco industry in the same era,” Glantz stated in a press release. “Our findings are a wake-up call for government officials charged with protecting the public health, as well as public health advocates, to understand that the sugar industry, like the tobacco industry, seeks to protect profits over public health.”

Thank you to everyone who entered our drawing for a brand new Waterpik Aquarius Professional Water Flosser. We dropped all the names into a hat and picked one from the bunch.

And the winner is (drumroll)…Stephanie Grisales! Congratulations, Stephanie!

Even if you have to buy your own irrigator, though, we think it’s a great investment – especially if you have trouble with gum disease or dislike conventional flossing (though truth be told, the two generally go together). Research shows that tools like the Waterpik are a boon for oral health (which, in turn, supports your overall health). Here are a few more good reads on the why which may motivate you to take your home hygiene to a new level:

I had two months to gather my thoughts and memories; two months to condense more than 50 years in dentistry, from my days at the University of Washington Dental School in Seattle through decades of private practice; two months to distill my life’s work and calling into just 20 minutes. I confess, my talk ran a little long, but there was much to share about how and why we brought biological dentistry to where it stands today.

After my talk, past-IABDM president Dr. Bill Glaros surprised me with the first of what’s to become an annual leadership award that will bear my name. Suffice it to say, I was totally overwhelmed by this honor.

The Opening to a New Horizon

Most of my preparation for that day was spent among the books, binders and manual that fill the bookcases and large parts of the floor space of my home office. But there’s also a huge picture window that looks out on our spacious backyard. There’s a beautiful pool and redwoods, lawn and rose bed, dozens of planters that go lush with greenery and flowers from early spring into deep autumn. It’s a wonderful sight to gaze on, whether to clear the mind, focus or reminisce.

My first real introduction to biological dental medicine happened in the summer of 1984, when I attended a conference at Children Shriner’s Hospital in Honolulu. The presenter who convinced me that the traditional dental school education was unsound and harmful was Reinhold Voll (1909-1989), a physician from Plochingen, Germany.

Dr. Voll was assisted by a very capable translator from Chile, Alberto Duque. Local health professionals from several disciplines brought patients to the conference for Dr. Voll to evaluate. Photos and x-rays of their teeth were projected onto a screen as Dr. Voll examined them with the Dermatron, his electro-dermal screening unit. As he did, Duque described which meridians Dr. Voll was measuring, the readings and pertinent remarks.

What Dr. Voll did not do was ask directly about either symptoms or diagnoses. He only examined them with the Dermatron – about 30 minutes per patient – then asked them and their practitioner to leave the auditorium for a while.

Dr. Voll would then discuss his findings, both medically and dentally. He shared his thoughts on what symptoms the patient was experiencing and how the medical establishment would likely diagnose those signs. He then asked the patient and practitioner to return and tell the audience about the dental or medical problems the patient was having. Questions from the audience were encouraged for further clarification and understanding.

I was blown away by this, by how accurately Dr. Voll had assessed each patient. I was totally impressed and astonished at the impact that dental conditions could have on an individual’s systemic health.

At this point, I had been practicing general dentistry for nearly 20 years. I had not been taught how harmful mercury amalgam “silver” fillings, root canal filled teeth, implants and chronic jaw osteitis lesions (“cavitations”) can be. Surely, the dentists who came to hear Dr. Voll speak knew that things like periodontal disease, caries (tooth decay/cavities) and orthopedic/orthodontic misalignments were trouble. How many knew about the rest?

As the conference continued, so did the shaking of my core beliefs. It felt like I was going through some kind of a career midlife crisis!

A System More Than Merely “Broken”

Every day, the media regales us with stories of ever-increasing scientific knowledge and supposed medical “miracles” through new therapies, diagnostic tools and other advanced technologies. Medical professionals are particularly bombarded with hype over the latest drugs to manage symptoms of any type of illness, dysfunction or syndrome you care to name.

One “side effect” they never mention: How drug-driven medicine often distracts the health professional, effectively dulling their sixth sense – the intuitive hunch, the inner eye, the gut feeling that supports the ability to diagnose safely and quickly, even in the most primitive conditions.

Even more disturbing are the “side effects” of these drugs – though accuracy demands we understand they are direct effects, just ones that aren’t desirable in a specific situation. Their drag on health is a powerful reminder that these chemical compounds are inherently noxious.

They’re also part of the reason why we see an increase in faulty diagnoses and therapies – like in the case of a local family I read about not long ago in the newspaper. They had sued Kaiser after repeated ER misdiagnoses that ultimately contributed to her death. They told her she had sciatic nerve pain. She died of sepsis.

Such cases are yet another factor keeping emergency rooms, clinics and hospitals pushing capacity. Practitioners then become more like traffic cops; clinics and hospitals become more like assembly lines. And the vicious cycle continues.

We’re also starting to hear more expressions of disillusionment coming from within the profession – as in cardiologist Dr. Sandeep Jauhar’s recent book Doctored: The Disillusionment of an American Physician. “It occurs to me,” he writes,

that my profession is in a sort of midlife crisis of its own. In the last four decades, doctors have lost the special status they used to enjoy. In the mid-twentieth century, at least, physicians were the pillars of any community. They made more money and earned more respect than just about any other type of professional. If you were smart and sincere and ambitious, the top of your class, there was nothing nobler or more rewarding that you could aspire to become. Doctors possessed special knowledge. They owned second homes. They were called upon in times of crisis. They were well-off, caring, and smart, the best kind of people you could know.

Today medicine is just another profession, and doctors have become like everybody else: insecure, discontented, and anxious about the future. In surveys, a majority of doctors express diminished enthusiasm for medicine and say they would discourage a friend or family member from entering the profession. In a 2008 survey of twelve thousand physicians, only 6 percent described their morale as positive.

Reasons for discontent include not having enough time to spend with patients because of paperwork. But Jauhar also hates what one reviewer described as “the assembly-line medicine that makes doctors little more than electronic medical record scribes with the power to instantly order tests and medicines but no time to build relationships.”

Lest you think it’s just his own griping, Jauhar relates similar disillusionment shared by other medical professionals in venues like SERMO, a social networking site for physicians, which presents itself as a virtual doctor’s lounge, where physicians can speak freely and anonymously. Says one cited by Jauhar,

I get too little respect from patients, physician colleagues, and administrators, despite good clinical judgment, hard work, and compassion for my patients. Working up patients in the ER these days involves shotgunning multiple unnecessary tests (everybody gets a CT!) despite the fact that we know they don’t need them, and being aware of the wastefulness of it all really sucks the love out of what you do. I feel like a pawn in a money-making game for hospital administrators. There are so many other ways I could have made my living and been more fulfilled. The sad part is we chose medicine because we thought it was worthwhile and noble, but from what I have seen in my short career, it is a charade.

When a new patient comes to our office, one of the forms we ask them to fill out asks them to describe their reasons for seeking dental care in our office – at whatever length they care to tell us their needs and concerns. Often, this elicits a response like, ‘I can’t believe it!” When we ask what they mean, they explain that the request is so unlike anything they have experienced in a dental or medical practice.

What they typically experience is like what one patient recently described about her first appointment at a new physician’s office:

I went to my physician about two weeks ago for my annual checkup /physical. The nurse took my weight, blood pressure, pulse and temperature. Then the doctor walked in, gave me a 10 second look and greeting and started typing on his computer. I answered a few questions; he typed some more. After that, some clicking and a short speech on the importance of flu shots, but when I said that I read that flu shots this year were only 23% successful, he gave me a quick farewell without answering my question. He only gave me a few seconds of eye contact. He never touched me. He is supposed to be a good doctor. All of this took between 9 and 10 minutes!

My take on this entire situation is that it leaves me sad and wondering if this medical system is far from merely “broken.”